Construction of a deep ocular prosthesis socket using a concave bowl-shaped composite graft from the conchal cymba

Background

A deep socket is needed to wear an ocular prosthesis stably in patients with anophthalmia, hypophthalmia, or post-inflammatory fornix adhesions. This report introduces the novel approach of reconstructing a deep fornix using a composite graft from the conchal cymba.

Methods

Four patients who underwent construction of an inferior fornix by means of a composite graft obtained from the conchal cymba at Shinshu University Hospital between 2004 and 2024 were retrospectively studied. We analyzed graft size, postoperative outcomes, and complications.

Operative technique

A composite graft from the conchal cymba was harvested in patients unable to wear an ocular prosthesis. The shallow inferior fornix was incised horizontally, and a vestibule for the composite graft was created by blunt dissection, taking care not to damage the septum. We drilled square holes of 1 × 1 mm into the cartilage side of the composite graft, which was then transplanted into the space created in the fornix and fixed with gauze.

Results

The composite graft survived in all 4 patients who underwent reconstruction of the inferior fornix using this technique. All patients were able to wear an ocular prosthesis stably and reported satisfaction with their aesthetic improvement at 6–27 months of follow-up. No major procedure-related adverse events were recorded.

Conclusions

A deep concave vestibule was constructed in a single operation using a bowl-shaped composite graft obtained from the conchal cymba. This novel method may enable ocular prosthesis fitting by constructing a deep and stable socket.